Cigna Corp. will redesign the HIV prescription drug benefits on its exchange plans sold in Florida next year in response to a complaint accusing the company--and three others--of discriminating against customers with HIV and AIDS, The Wall Street Journal reported.
The AIDS Institute and the National Health Law Program complained to the federal government that Cigna, CoventryOne (which is part of Aetna, Inc.), Humana, Inc. and Preferred Medical Plan place all HIV medications-- including generics--on top formulary tiers. This placement requires patients to pay up to half the drugs' out-of-pocket costs. Patients on expensive drug regimens for HIV can pay thousands of dollars in monthly costs, as FierceHealthPayer reported.
Since the Affordable Care Act prohibits discrimination against those with pre-existing conditions, payers can't deny them coverage or charge them more than healthier people; but it's not yet clear what constitutes discrimination under the law. The discrimination complaint in this matter is pending, The WSJ noted.
Meanwhile, Cigna entered a consent order with Florida regulators, agreeing to move generic HIV medicines into a cheaper formulary tier, to cap copayments at $200 per month for each of four other HIV drugs and to remove preauthorization requirements for refills. The $200 cap applies only to 2015 plans, the newspaper added, and Cigna admits no wrongdoing in relation to the complaint.
James Card, a spokesman for Preferred Medical, told The WSJ that medications for HIV and other medications formerly in the specialty tier would be distributed across all formulary tiers in its 2015 plans.
Matthew Wiggin, a spokesman for CoventryOne, said the insurer's current exchange offerings "provide access to HIV care that follows the latest HHS guidelines and evidence-based practices," and that its formularies comply with ACA rules.
Alex Kepnes, director of communications at Humana, told the newspaper the insurer doesn't discriminate against anyone and is actively working with Florida regulators "to address concerns."
- read The WSJ article